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    SINGAPORE (CNN) -- CNN's TALK ASIA is granted special access to Dr. Margaret Chan, Director-General of the World Health Organization (WHO), at her first public appearance in Singapore. She joins CNN's Anjali Rao for an in-depth discussion on avian flu, HIV AIDS and other global public-health emergencies. AR: Talk Asia's host, Anjali Rao AR: So this is your first public appearance since you got your new job. Congratulations, by the way. I was noticing earlier on, this place is absolutely swarming with security and people with huge guns just ahead of your arrival. Do you feel like a rock star? MC: No, I don't. Actually I feel like a servant. I have 193 member states and I work with them very closely for the health of the world's people. AR: The point of this forum is international health security. What are the biggest challenges you think in protecting the world's people? MC: I think it is important as we have learned from experience, I mean, new and emerging infections keep coming back and the world needs a collective defense system, and that requires international cooperation and collaboration, in the name of global solidarity. Because you know, the strongest countries or the wealthy countries should work through WHO to support resource-poor countries so they can build the capacity for disease surveillance, early reporting and response. Now without that kind of global-defense system, no matter how well the developed countries are prepared, the weakest link will be in countries where they have weak health systems. So every nation is, you know, in the same boat, and we call this universal vulnerability. AR: There are so many health concerns at the moment, and of course bird flu is a very, very serious one of them, and its potential of course to become pandemic. How close do you think we are to that happening? MC: Well, everybody would like to know the answer to your question, and you know, I've been talking to scientists, I've been talking to my technical experts. I don't believe scientists or technical experts have an answer to this question. The timing to the next pandemic is unpredictable, and whether the next pandemic is going to be severe or mild and which avian influenza would cause the outbreak again... These are questions we don't have answers to at this point in time, but it is interesting, though I mean in the last two to three years we are getting signals and warnings from nature, so to speak. We are seeing an unprecedented spread of avian influenza outbreak. It has moved outside South East Asia focus and it has spread to the Middle East, it has spread to Europe and to Africa. Now we have never seen anything quite like it. So given the situation, it is our duty in the WHO to advise countries to prepare for the pandemic. AR: One of the most seriously affected countries by bird flu has been Indonesia, which now says, has said, in the last couple of days, that it will start sharing virus samples with the WHO. Are you able to convince them though to share the samples with the drug companies who are trying to make a vaccine for it? MC: I think first and foremost, I would like to commend the government of Indonesia for being very transparent. I mean, in the last two years since working with them, they have always reported their case very promptly. And of course, you know, again the government of Indonesia, led by the president himself and the minister of health, brought the very important issue to the world's attention, and that is access to pandemic influenza by resource-poor countries. Now this is a very important issue. Now we are exploring the idea of a global stockpile of vaccine. And then the second issue is to find resources to support countries who are willing to invest in building their own vaccine-manufacturing capacity, so through technology transfer we would like to support the developing countries, including Thailand, Indonesia, India and Brazil, who have shown interest. AR: You've certainly got plenty of experience in handling bird flu when it first appeared in Hong Kong. You made decisions that in retrospect seemed like the right ones, but at the time you took a lot of flak for them -- for one ordering the culling of 1.5 million chickens and also for something that you said, you said: "Hey, don't worry. I eat chicken every day," and the first five people died shortly thereafter. Any regrets with the way you tackled it? MC: I think I learned two lessons there. OK, let me share them with you. First and foremost, sometimes one has to be more sensitive to the feeling of the community. Now at the time, there was a level of anxiety and worry in the community. The fact that I mentioned I eat chicken every day, it is factually correct, and also we have no evidence that anybody eating well-cooked chicken would come down with the disease. Perhaps we could be more sensitive to the feeling of the community rather than just relying on pure science and evidence. You see my point. The second lesson there that we learned is that in public health, especially when you're dealing with new and emerging infections, science is always lagging behind time and in the absence of solid evidence. But based on the best available information and evidence, one has to make difficult and often times unpopular decisions. Of course the recommendation to the government then to slaughter 1.5 million chickens was a very difficult decision we took, but all in all, that was the right decision. I mean now the slaughtering of the infected chicken is the gold standard, so I mean this is something we need to face in public health. AR: What are your thoughts on the potential to eradicate it once and for all? MC: Well, HIV AIDS, you know, is a big pandemic and affecting many countries in the world. And at this point in time it is important for us to work with partners to address the issue, and we need to look at the total package, you know, prevention, care and treatment are part of the total package that is required. Before we come up with antiretro virals, people infected with HIV aids really died from the disease. Now with medicines they can continue and run a normal life. AR: It's prolonging the inevitable though, isn't it? MC: I mean, it has, some of our scientists say, become a chronic disease. So at least you know the medicine offers hope to people. It's important. AR: But then you've got people in, you know, poorer countries, for example Africa and also China, which downplayed it for so many years. What do you think of the way that China is now dealing with it? MC: HIV AIDS is a disease with stigma. And we have learned with experience, not just with HIV AIDS but with other diseases, countries for many reasons are sometimes hesitant to admit they have a problem. But time and time again, evidence has proven that countries that admit they have a problem actually turn out to be in a better position in dealing with the issue, managing the problem. Let's use Thailand as an example. Thailand was very upfront about, you know, they have a problem with HIV AIDS, and the government was very aggressive and determined, with adverts to minimize the infection, and we are now beginning to see good results of their tremendous efforts. I'm happy to see that the government of China in the last few years under the new leadership admitted they have a problem, and they are addressing the problem. They are investing more resources to improve the situation, but of course much needs to be done. AR: Speaking of China, you are the first Chinese national to head a key UN agency. It was always said you had a very fractious relationship with China. You yourself said, "I don't really know why they nominated me for the WHO post." What's your relationship like with them now? Because some have surmised that suddenly you have a red phone to Beijing? MC: Well, whether or not I have a red phone to Beijing is speculation. But it is true that at some point when China suggested me, nominated me to run, the reason I asked that question is that there are many very experienced and competent people in China and I was, you know, very pleased, of course, and feel very privileged to have the trust of the central government in nominating me. This is one job that I really have a lot of respect for, and it is not an easy job, but it is a rewarding job if you can really make a difference. AR: You certainly trod on a few toes during the SARS crisis when you demanded that China come clean about the problem that it was having there, it really wasn't doing that at the time. What are you up against when you are trying to convince a country that has traditionally been closed, such as China, to be open to the world? MC: I think it is important for us to realize that, you know, every area or country needs to go through a process of change and reform, and I am happy to say that I am seeing very good progress in China. Yes, during SARS I was very upfront and very direct, because as I said our transparency is important. AR: China still puts its foot down as far as Taiwan is concerned. Taiwan wants to be admitted into the WHO as a separate country in its own right. Any plans to let that happen? MC: I'm the administrative and technical chief of the organization. I implement policies of the organization, and the policies are set by the member states. Our 193 member states still hold on very strongly to the One China principle. Health is an issue that China pays a lot of attention to, and I was reminded again and again under special circumstances that China would be very receptive for WHO to work with Taiwan directly. AR: Clinics like this are part of the first line of defense in dealing with illnesses. What do you make of the way that medical workers in the grassroots levels -- doctors and nurses -- are able to deal with diseases here in Asia? MC: I think this polyclinic model in Singapore is a wonderful example of primary health care in the sense of providing holistic and comprehensive care. Not just involving the doctors, they use nurses and other health care providers to provide team approach. AR: As a physician it must be difficult when new diseases pop up, because essentially you're dealing with a blank canvas, an unknown quantity. How do doctors tackle it when these new ones pop up? MC: Doctors and nurses, with their training and their experiences, they would be able to detect unusual patterns of disease. That's why we say it is important for every country to have a proper surveillance system. The function of the surveillance system is to detect unusual patterns of diseases. And especially when you have a very good database to help you to [appreciate] what are some of the normal disease events you see on a regular basis. Anything out of the ordinary, anything presented as unusual, experienced doctors and nurses would be able to pick up the event, and then they say, let's go integrate the details and find out what's so unusual about the event. AR: You've been Director-General of WHO since January 2007. I imagine it's not the easiest job in the world, but how would you sum it up so far? MC: You're right, it is not an easy job, but I am enjoying it tremendously. It is an honor and a privilege to be given this position to serve the world's population. We are into very exciting times so I enjoy it tremendously. AR: When you took this job, you pledged to address the issues of Africa and particularly its female population, but how much realistically do you think you can achieve, given the scale of the health problems there and also the cultural issues? MC: Well, I would like to look at the issue from two perspectives. First and foremost to reinforce what you have said. Africa is a continent, particularly looking at the sub-Saharan countries in Africa. They have about 11 percent of the world's population. And in terms of disease burden, this group of countries is suffering about 25 percent. And yet they only have 3 percent of the world's human resources, so there is a disparity there. There is not enough capacity, and that is evidence and statistics. But the good thing is there is a lot of commitment from many countries who are willing to provide support to Africa, either through bilateral arrangement or through multilateral organizations, international organizations like WHO. Now we should not tell the country what they need, the country is better positioned to know what is important for them. So we need to support their efforts to achieve what is important for the health of their people. Now I am optimistic, when the stake players come together, align ourselves, make sure we are coherent and we can get synergy and added value. If we are seeing improvement in the HIV AIDS situation, reducing the number of malaria cases, managing tuberculosis, women's health and children's health, those are the results we want to see on the ground. AR: The UN has been slated for being mired in red tape, there's a lot of talk going on, but not a lot of action. Do you think that you're going to help to dispel that image of an ineffectual bureaucracy? MC: I think UN organizations are important organizations. They exist for good reasons. And we also admit that there is room for us to improve the way we do business. The WHO will be a very positive and proactive partner in the overall UN reform, which is also important. Because the countries themselves are in the driver's seats. The countries must have their ownership, and we are there to support them. The UN agencies need to align our work with the country's priorities. So at the end of the day, if we are all committed to UN reform to seek country results, to serve countries, I think I'm quite optimistic. AR: Dr. Chan, thank you very much for your time indeed, it's been great having you on our show. MC: Pleasure to be here. |
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